Instrument for endoscopic applications or the like

ABSTRACT

An instrument for endoscopic applications, including a tubular member having a handling end portion having a flexible portion and actuating devices located at the other end portion, and longitudinal elements for transferring the movement of the actuating devices to the handling end portion resulting in a change of orientation thereof, whereby the handling end portion includes at least two independent flexible portions, whereby the actuating end portion has a corresponding number of actuating devices, and whereby each actuating device is connected by its own set of longitudinal elements to a part of the handling end portion for effecting a change of orientation of one of the flexible portions.

BACKGROUND OF THE INVENTION I. Technical Field

The invention relates to an instrument for endoscopic applications orthe like, comprising a tube like member having a handling end portionhaving a flexible portion and actuating means located at the other endportion, and longitudinal elements for transferring the movement of theactuating means to the handling end portion resulting in a change oforientation thereof.

II. Description of the Related Art

Such an instrument is known from EP-A-1 708 609 and is normally used forapplications such as minimal invasive surgery, but it is also applicablefor other purposes such as the inspection or reparation of mechanical orelectronic installations at locations which are difficult to reach.

In this known instrument a bending movement of the actuating end portionis transferred to a handling end portion by means of the longitudinalelements resulting in a corresponding bending movement of the handlingend portion especially of the flexible part thereof. As a result of thisconstruction the bending orientation of the flexible portion is limitedto one direction at a time, as a result of which the application of thistype of instrument is limited. This is especially true in situationswhere two endoscopic instruments are used in a parallel fashion locatedside by side, as in this situation it is not possible to direct thehandling end portion to the same point because of the mutual sphericalhindrance. Furthermore it is not always possible to use the instrumentat defined locations because of some obstacles present in the accessroad to the point where some action is needed. More specifically thereis a need for an instrument for endoscopic applications or the likewhich offers advanced possibilities in the guidance of the handling endportion of the instrument.

SUMMARY OF THE INVENTION

It is therefore an object of the invention to provide an instrument ofthe above named type which avoids the above cited problems and offersmore versatile application possibilities.

This and other objects are obtained in that the handling end portioncomprises at least two independent flexible portions, in that theactuating end portion has a corresponding number of actuating means, andin that each actuating means is connected by means of its own set oflongitudinal elements to a part of the handling end portion foreffecting a change of orientation of one of the flexible portions.

As a result of the fact that the handling end portion contains at leasttwo independently controllable flexible portions it becomes possible tomake more complicated curves allowing better access to difficult placesand more versatile use of the instrument. For instance in case of twoflexible portions in the handling end portion it is possible to makeS-curves allowing to use parallel endoscope instrument in approachingthe same point of operation.

BRIEF DESCRIPTION OF THE DRAWINGS

Other characteristics and advantages of the invention will become clearfrom the following description reference being made to the annexeddrawings. In the drawing is:

FIG. 1 a schematic cross-section view of an instrument according to theinvention,

FIG. 2 a schematic cross-section view of the instrument of FIG. 1showing a first step of its operation,

FIG. 3 a schematic cross-section view of the instrument of FIG. 1,showing the second step of its operation,

FIG. 4 a schematic cross-section view showing a with respect to FIG. 1modified embodiment of an instrument according to the invention,

FIG. 5 a schematic cross-section view showing a with respect to FIG. 4modified embodiment of an instrument according to the invention,

FIG. 6 a schematic cross-section view showing a with respect to FIGS. 4and 5 modified embodiment of an instrument according to the invention,

FIG. 7 a perspective view of an actuator to be used in an instrumentaccording to the invention,

FIG. 8 a perspective view of a modified embodiment of an actuator to beused in a instrument according to the invention,

FIG. 9 a schematic cross-section view of an embodiment of an instrumentaccording to the invention having a four level control system,

FIG. 10 a schematic view of the instrument according to FIG. 9 in theneutral position,

FIG. 11 a schematic view of the instrument according to FIG. 9 with onelevel of the control system activated,

FIG. 12 a schematic view of the instrument according to FIG. 9 with twolevels of the control system activated,

FIG. 13 a schematic view of the instrument according to FIG. 9 with allfour levels of the control system activated,

FIG. 14 a schematic perspective view of a part of an instrumentaccording to the invention with four levels of actuation in which thefour levels are located within the same layer or cylindrical element,

FIG. 15 a schematic perspective view of the instrument of FIG. 14 withpart of the external layer or cylindrical element removed,

FIG. 16 a schematic drawing of a possible application of the instrumentin an endoscopic application,

FIG. 17 a cross section according to the line XVII-XVII in FIG. 16,

FIG. 18 a schematic perspective view of a part of an instrumentaccording to the invention with eight levels of actuation in which fourlevels are located in a first layer or cylindrical element and the fourremaining levels are located in another layer or cylindrical element,

FIG. 19 a schematic perspective view of the instrument of FIG. 18 withpart of the external layer or cylindrical element removed,

FIG. 20A, B, C and D schematic views of an application of the endoscopicinstrument according to the invention,

FIG. 21A, B, C and D schematic view of a modified embodiment in anapplication of the endoscopic instrument according to the invention,

FIG. 22 a schematic cross-section of an instrument according to theinvention,

FIG. 23 an exploded view of the three cylindrical members forming theinstrument according to the invention, and

FIG. 24 an unrolled view of a part of the intermediate cylindricalmember of the instrument according to the invention.

DETAILED DESCRIPTION OF THE INVENTION

The instrument as shown in the annexed drawings can be used forendoscopic medical applications, but its use is not restricted to that,as it may be used in other applications, such as technical applicationsfor handling or viewing parts of machines or installations which areotherwise difficult to reach. Endoscopic instrument as used in thisdescription will include also these applications.

The instrument as shown in FIG. 1 comprises four layers or cylindricalelements, a first internal layer or cylindrical element 1, a secondintermediate layer or cylindrical element 2, a third intermediate layeror cylindrical element 3 and a fourth external layer or cylindricalelement 4, the four elements 1, 2, 3 and 4 being co-axial andsurrounding each other as shown.

The first internal layer or cylindrical element 1 as seen along itslength is composed of a first rigid ring 11, which is the handling endportion, which means that this portion is used at a remote place whichis difficult to reach to perform some action, a first flexible portion12, a first intermediate rigid portion 13, a second flexible portion 14,a second intermediate rigid portion 15, a third flexible portion 16 anda second rigid end portion 17, which is used as the actuating endportion of the instrument, which means that this end portion is used tocontrol the movement of the other end portion 11.

The first or inner intermediate layer or cylindrical element 2 is asseen along its longitudinal direction composed of a first rigid ring 21,a first flexible portion 22, a first intermediate rigid portion 23, asecond flexible portion 24, a second intermediate rigid portion 25, athird flexible portion 26 and a second rigid end portion 27. Thelongitudinal dimension of the first rigid portion 21, the first flexibleportion 22, the first intermediate rigid portion 23, the second flexibleportion 24, the second intermediate rigid portion 25, the third flexibleportion 26 and the second rigid end portion 27 are approximately equalto the longitudinal dimension of the first rigid portion 11, the firstflexible portion 12, the first intermediate rigid portion 13, the secondflexible portion 14, the second intermediate rigid portion 15, the thirdflexible portion 16 and the second rigid end portion 17 respectively andare coinciding with these portions as well.

The second intermediate layer or cylindrical element 3 is as seen alongits longitudinal direction composed of a first rigid ring 31, a firstflexible portion 32, a second rigid ring 33, a flexible portion 34, afirst intermediate rigid portion 35, a first intermediate flexibleportion 36, a second intermediate rigid portion 37, a secondintermediate flexible portion 38 and a second rigid end portion 39. Thelongitudinal length of the first rigid end portion 31, the firstflexible portion 32 together with the second rigid ring 33 and thesecond flexible portion 34, the first intermediate rigid portion 35, thefirst intermediate flexible portion 36, the second intermediate rigidportion 37, the second intermediate flexible portion 38 and the secondrigid end portion 39 are approximately equal to the longitudinaldimension of the first rigid ring 11, the first flexible portion 12, thefirst intermediate rigid portion 13, the second flexible portion 14, thesecond intermediate rigid portion 15, the third flexible portion 16 andthe second rigid end portion 17 respectively and are coinciding withthese portions as well.

The fourth external cylindrical element 4 is as seen along itslongitudinal direction composed of a first rigid ring 41, a firstflexible portion 42, a first intermediate rigid portion 43, a secondflexible portion 44, a second rigid ring 45. The longitudinal length ofthe first flexible portion 42, the first intermediate rigid portion 43and the second flexible portion 44 are approximately equal to thelongitudinal dimension of the second flexible portion 33, the firstintermediate rigid portion 34 and the first intermediate flexibleportion 35 respectively and are coinciding with these portions as well.The rigid rings 41 and 45 can have only a very limited length and thering 41 has approximately the same length as the ring 33 and isconnected thereto, whereas the ring 45 extends only over the rigidportion 37 with a length which is sufficient to make an adequateconnection between the portions 45 and 37 respectively. The end faces ofthe rigid rings 11, 21 and 31 can be connected to each other and thesame applies to the end faces of the end portions 17, 27 and 39.

The internal and external diameters of the cylindrical elements 1, 2, 3and 4 are chosen in such a way that the external diameter of the element1 is almost equal to the internal diameter of the element 2, theexternal diameter of the element 2 is almost equal to the internaldiameter of element 3 and the external diameter of the element is almostequal to the internal diameter of the element 4, in such a way that asliding movement of the adjacent elements with respect to each other ispossible. The flexible elements 12, 42, 14, 44, 16 and 38 can beobtained by the methods described in the European patent application 08004 373.0 filed on Oct. 3, 2008, page 5, lines 15-26, but any othersuitable process can be used to make flexible portions. Otherwise theportions 22, 23, 24, 25, 26 and 34, 35, 36 are comparable to thelongitudinal elements described in the above mentioned European patentapplication for transferring the movement of one portion of theendoscopic instrument to another portion or ring. Any embodimentdescribed in that patent application can be used according to theinvention. Otherwise the longitudinal elements can also be obtained byany other system known in the art such as for example described inEP-A-1 708 609. The only applicable restriction with respect to theconstruction of the longitudinal elements used in these portions is thatthe total flexibility of the instrument in these locations where theflexible portions coincide must be maintained.

The different layers or cylindrical elements as described above may beproduced by any of the known processes, provided that they are suitableto make a multilayer system. Under multilayer it must be understood anendoscopic instrument having at least two separate systems oflongitudinal elements for transferring the movement of the actuating endportion to the handling portion. The assembling of the differentcylindrical elements can be performed in the same way as well. Preferredprocesses for producing the different cylindrical elements have beendescribed in the above mentioned European patent application 08 004373.0 filed on Oct. 3, 2008 which is here incorporated by reference.

In FIG. 22 there is shown an axial cross-section of an instrument 201according to the invention. The instrument 201 is composed of threecoaxial cylindrical members an inner member 202, an intermediate member203 and an outer member 204. The inner cylindrical member 202 iscomposed of a first rigid end part 221, which is the part normally usedat the location which is difficult to reach or inside the human body or,a first flexible part 222, an intermediate rigid part 223, a secondflexible part 224 and a second rigid end part 225 which is normally usedas the operating part of the instrument in that it serves to steer theother end of the unit. The outer cylindrical member 204 is in the sameway composed of a first rigid part 241, a flexible part 242, anintermediate rigid part 243, a second flexible part 244 and a secondrigid part 245. The length of the different parts of the cylindricalmembers 202 and 204 are substantially the same so that when thecylindrical member 202 is inserted into the cylindrical member 204, thedifferent parts are positioned against each other. The intermediatecylindrical member 203 also has a first rigid end part 231 and a secondrigid end part 235 which in the assembled condition are located betweenthe corresponding rigid parts 221, 241 and 225, 245 respectively of thetwo other cylindrical members.

The intermediate part 233 of the intermediate cylindrical member isformed by three or more separate longitudinal elements which can havedifferent forms and shapes as will be explained below. After assembly ofthe three cylindrical members 202, 203 and 204 whereby the member 202 isinserted in the member 203 and the two combined members 202, 203 areinserted into the member 204, the end faces of the three members 202,203 and 204 are connected to each other at both ends so as to have oneintegral unit.

In the embodiment shown in FIG. 23 the intermediate part 233 is formedby a number of longitudinal elements 238 with a uniform cross-section sothat the intermediate part 233 has the general shape and form as shownin the unrolled condition in FIG. 24. From this it also becomes clearthat the intermediate part is formed by a number of over thecircumference of the cylindrical part 203 equally spaced parallellongitudinal elements 238. The number of elements 238 must be at leastthree, so that the instrument 1 becomes fully controllable in anydirection, but any higher number is possible as well.

The production of such an intermediate part is most conveniently done byinjection moulding or plating techniques or starting form a regularcylindrical tube with the desired inner and outer diameter and removingthese parts of the tube wall required to end up with the desired shapeof the intermediate cylindrical member. This removal of material can bedone by means of different techniques such as laser cutting,photochemical etching, deep pressing, conventional chipping techniquessuch as drilling or milling, high pressure water jet cutting systems orany suitable material removing process available. Preferably lasercutting is used as this allows a very accurate and clean removal ofmaterial under reasonable economic conditions. These are convenient waysas the member 203 can be made so to say in one process, withoutrequiring additional steps for connecting the different parts of theintermediate cylindrical member as was required in the conventionalinstruments, where the longitudinal members must be connected in someway to the end parts.

The use of the construction as described above allows the instrument tobe used for double bending as will be explained with respect to theFIGS. 2 and 3. For convenience reasons the different portions of thecylindrical elements have been named according to zones 51-60, in whichzone 51 is formed by the rigid rings 11, 21 and 31. Zone 52 is formed bythe portion 32 and the parts of the portions 12 and 22 coincidingtherewith. Zone 53 is formed by the rings 33 and 41 and the part of theportions 12 and 22 coinciding therewith. Zone 54 is formed by theportions 34 and 42 and the part of the portions 12 and 22 coincidingtherewith. Zone 55 is formed by the portions 13, 23, 35 and 43. Zone 56is formed by the portions 14, 24, 36 and 44, zone 57 is formed by ring45 and by the part of the portions 15, 25 and 37 coinciding therewith.Zone 58 is formed by the portion 37 and the part of the portions 15 and25 coinciding therewith. Zone 59 is formed by the portions 16, 26 and 38and zone 60 is formed by the portions 17, 27 and 39.

For operating the handling end portion of the endoscopic instrument asshown in FIG. 2, it is possible to apply a bending force, in any radialdirection, to the zone 58 so as to bend the zone 56. In view of theconnection by means of longitudinal elements formed by the portions 34,35 and 36 between the portion 37 and the ring 33 this bendingdeformation of the zone 56 is transferred by longitudinal displacementof portion 35, into a bending deformation in the zone 54 as shown.

The bending of the portion 24, and therefore the longitudinaldisplacement of portion 23, as a result of bending zone 56, is fullyabsorbed by bending of portion 22 where it coincides with the portion 33and will therefore not result in any deformation of the remaining of theportion 22 coinciding with the zone 52.

When subsequently and as shown in FIG. 3 a bending force, in any radialdirection, is applied to the zone 60 whereby the zone 59 is bended asshown, this will result in the bending of the zone 52, which is due tothe connection by means of longitudinal elements formed by the portions22, 23, 24, 25 and 26 between the ring 21 and the portion 27. Theinitial bending of the instrument in zone 54 will be maintained becausethis bending is directed by zone the bending of zone 56. This is why atthe handling end of the instrument a double bending is obtained causedby the individual bendings of the zones 52 and 54. In this way itbecomes possible to give the handling head of the instrument a positionand longitudinal axis direction that are independent from each other. Inknown instruments such as described in EP-A-1 708 609 the position andthe direction of the longitudinal axis are always coupled and can not beindividually controlled.

Obiously, it is possible to vary the length of the flexible portions asto accommodate specific requirements with regard to bendig radii andtotal lengths of the handling end and actuating end or to accommodateamplification ratios between bending of the actuating end and thehandling end.

In FIG. 4 there is shown a modified embodiment of the instrumentaccording to the invention. In this embodiment there is shown aninstrument having four layers and as such the instrument is comparableto the instrument of FIG. 1 but the actuating portion of the cylindricalelements has a larger diameter compared to the handling end portion andin the zone 56 a frusto-conical part has been incorporated. As a resultof the larger diameter of the actuating portion the movement of thehandling portion will be amplified upon bending thereby amplifying themovement of the handling head. It is also possible to work in theopposite direction with a handling portion with a larger diameter thanthe actuating portion whereby the degree of movement is decreased,thereby improving accuracy of movement of the handling head

In FIG. 5 there is shown an embodiment of an instrument according to theinvention which is comparable to the instrument as shown in FIG. 4 inwhich the movement of the actuating portions is amplified into amovement of the handling portion. Here also there is shown an instrumenthaving four layers as in the instrument of FIG. 1.

The left hand side with respect to the line A-A of the instrument asshown in FIG. 5, which is the handling end portion, is completelyidentical to the left hand side with respect to the line A-A of theinstrument as shown in FIG. 1. The right hand side with respect to theline A-A of the instrument as shown in FIG. 5 has been modified. Theinner layer or cylindrical element 1 can be completely identical to theinner layer 1 shown in FIG. 1. The outer layer or cylindrical element atthe right hand side of the line A-A has been modified in that itconsists of a rigid portion 65 connected to the left hand side and anend portion 66 connected to the right hand side. The rigid portion 65 isformed by a cylindrical element having a number of slits 67 parallel tothe axis of the instrument and regularly spaced around the circumferenceof the portion 65. The end portion 66 comprises a cylindrical bush 68provided with a ring flange 69 forming a spherical flange.

The right hand side of the instrument is further composed of twoactuating members 70 and 71. The actuating member 70 is a hollow tubelike element comprising a ball shaped member 72, a tube 73 and aspherical flange 74. The ball shaped member 72 fits into the thespherical flange 69 and in this way the member 70 is rotatably connectedto the left hand part of the instrument. The ball shaped member 72 isprovided with an annular flange surrounding the same and having two setsof openings, a first set positioned along a circle line around theflange 75 and a second set also positioned along a circle line aroundthe flange 75, the circle line of the first set preferably having a samediameter as the circle line of the second set. The actuating member 71is also a hollow tube like element comprising a ball shaped member 76and a tube 77. The ball shaped member 76 is comparable to the ballshaped member 72 and fits into the spherical flange 74 whereby themember 71 is rotatably connected to the member 70. The ball shapedmember 76 is provided with an annular flange 78 surrounding the same andprovided with a set of openings positioned along a circle line aroundthe flange 78.

The left hand part of the first intermediate layer or cylindricalelement 2 comprises the longitudinal elements of the portion 23. In theright hand part with respect to the line A-A, these longitudinalelements are guided through some of the slits 67, through the first setof openings in the flange 75 and into the openings in the flange 78 towhich they are connected. The left hand part of the second intermediatelayer or cylindrical element 3 comprises the longitudinal elements ofthe portion 35. In the right hand part with respect to the line A-Athese longitudinal elements are guided through some of the slits 67 intothe second set of openings in the flange 75 to which they are connected.

The operation of the instrument shown in FIG. 5 is comparable to theoperation of the instrument of FIG. 1. Any bending movement of themember 70 with respect to the flange 69 is translated into a bendingmovement of the zone 54, and any bending movement of the member 71 withrespect to the flange 74 is translated into a bending movement of thezone 52. As a result of the fact that the longitudinal elementscontrolling the bending are connected to the actuating members 70 and 71at points having a greater distance to the longitudinal axis of theinstrument than the corresponding elements at the other end of theinstrument, the bending movement of the members 70 and 71 is amplifiedinto a bigger bending movement of the zones 54 and 52 respectively, andas such its operation is comparable to that of the instrument of FIG. 4.

In the embodiment shown in FIG. 6 the handling end portion is identicalto the handling end portion of the embodiment shown in FIG. 5, whereasthe actuating end portion has been modified. Around the actuating endportion there is provided a cylindrical housing 80 which is mounted onthe external layer of the instrument. Furthermore the external layer ofthe instrument at the actuating end portion side is provided with acylindrical member 83 such that between the zone 55 and the cylindricalmember 83 a number of slits 67 are present as shown in FIG. 5. To theinner wall of the cylindrical housing 80 there are mounted two sets oflinear actuators 81 and 82 respectively. A linear actuator is a devicewhich can cause a translation movement of an element such as for examplethe longitudinal elements in this type of endoscopic instruments. Suchlinear actuators are generally known in the art and will not bedescribed in more detail here, and they can be controlled by electronicdevices such as computers.

The longitudinal elements of the outer intermediate layer are passingthrough the slits 67 and connected to the set 81 of linear actuators.The longitudinal elements of the inner intermediate layer are passingthrough the cylindrical member 83 and connected to the second set 82 oflinear actuators. By means of a correct actuation of the linearactuators 81 and 82 the orientation of the flexible zones 52 and 54 canbe changed so that the same effects obtained as with the instrumentaccording to FIG. 5 or FIG. 1, which means that more curves can be madeby the handling end portion. It is necessary that the actuation of thedifferent linear actuators is done in a controlled manner as otherwisethe change of orientation cannot be performed. This means that if oneactuator 81 is exerting a pulling force on its longitudinal element, theother actuators must be acting in a corresponding way, which meanseither exerting a smaller pulling force or exerting a pushing force sothat the whole is in balance. The same applies if both sets of actuatorsare activated simultaneously.

In case the number of longitudinal elements is larger than three whichis mostly required to have a smooth transition of the movement of theactuating end portion to the handling end portion, the electroniccontrol of all linear actuators may become complicated. In the FIGS. 7and 8 there are shown two solutions for such a system. In the embodimentof FIG. 7 a disc 85 is mounted movable on the cylindrical element 83 bymeans of a ball bearing 90. The disc 85 is provided with a number ofopenings 88 along its outer circumference and the longitudinal elementsare connected to the disc through these openings. As such the operationof the disc 85 is comparable to that of the disc 75 in FIG. 5. Two ofthe openings 88 are connected through elements 86 to a linear actuator87. If the two openings 88 are not diametrically opposed to each otherwith respect to the axis of the cylindrical member 83, the movement ofthe two actuators 87 is sufficient to control fully the orientation ofthe disc 85 and thereby the movement imposed on the corresponding zoneof the handling end portion.

In the embodiment shown in FIG. 8 the disc 85 is not supported by a ballbearing on the cylindrical member 83, but three of the openings 88 arethrough elements 86 connected to linear actuators 87 and also supportedby that. These three actuators 87 are controllable to fully control theorientation of the disc 85 and thereby the movement of the correspondingzone of the handling end portion.

In this way the electronic control of the longitudinal elements throughlinear actuators is reduced to the electronic control of either three ortwo s such actuators which is less complicated than the full control ofall longitudinal elements.

A possible medical application of such instrument is shown in FIGS. 16and 17. In this application one tubular feed through can be used toenter a body through one incision or hole. Through this feed throughmultiple endoscopic instruments having a body as per the invention canbe passed trough channels that are parallel without space between thosechannels as is illustrated in FIG. 17. When a tubular feed trough likethis is used for instruments as described in EP-A-1 708 609 it is notpossible to manipulate the handling end portions of these instrumentssuch that the longitudinal axes through the handling ends cross throughthe same point. Therefore these instruments strongly limit theapplication and freedom to act of the operator of the instruments. Wheninstruments are used as per the invention, it is possible to maneuverthe handling tips such that both instruments can be simultaneously usedin which for example one instrument could hold tissue and the otherinstrument could cut free this tissue. The strong advantage of theinvention therefore is that it enables the use of multiple instruments,without strong limitations to maneuverability and simultaneous use andthat these instruments can be used as such through only one accessopening in the body.

When expanding the idea of a system of having more than one system oflongitudinal elements and having a corresponding number of flexibleportions it is possible to even make more complicated curves.

In FIG. 9 there is shown an instrument according to the invention whichis composed of six layers, allowing the instrument with a handlingportion which can be curved in a more complicated way as shown in theFIGS. 10, 11, 12 and 13. The basic construction shown in FIG. 1 has beenmaintained, in that this instrument has an inner and an outer layer 100and 106 comparable to the inner and outer layer 11 and 14 of FIG. 1,except that the number of flexible portions has been increased takinginto account the number of intermediate layers. In this way the handlingend portion has been provided with four flexible portions, whereas theactuation portion also has four flexible portions. The flexible portionsin the handling end portion are separated by very short rigid portionsas in the embodiment of FIG. 1, and the flexible portions in theactuation end portions can be separated by longer rigid portions. Byconnecting the different rigid portions in the handling end portion withthe corresponding rigid portions in the actuation end portion by meansof longitudinal elements, the different flexible portions in thehandling end portion can be bended in accordance with the bending of theflexible portions in the actuation end portion.

The operation is shown in the FIGS. 10, 11, 12 and 13. In FIG. 10 theinstrument is shown in its starting position or shape. In FIG. 11 theflexible portion 113 has been bended over a defined degree by means of abending of the flexible portion 117. By an additional bending of theflexible portion 114, the flexible portion 110 has been curved over adefined degree whereby the shape or configuration as shown in FIG. 12has been obtained. When subsequently defined curves have been applied tothe flexible portions 115, 116, corresponding curves can be obtained inthe flexible portions 111, 112, resulting ultimately in theconfiguration shown in FIG. 13. Here is it must be remarked that thedifferent curves made to the flexible portions 114, 115, 116 117 neednot to be in the same plane, but that the plane of bending may bedifferent for each flexible portion, whereby the curves obtained in theflexible portions 110, 111, 112 and 113 are also positioned in differentplanes. In this way it becomes possible to give complex configurationsto handling end portions. This may be very important in all applicationswhere it may be required to follow well defined paths in order to reachdefined locations. It is obvious that also in case of more than fourlayers it is possible to use actuation and amplification such asdescribed as in FIGS. 4, 5, 6, 7 and 8.

Theoretically an instrument can be made with an indefinite number ofbending portions and corresponding layers, and as the number of layerswill increase the possibilities of performing complicated curves willincrease. However as the number of layers will increase also the outerdiameter of the instrument will become bigger, specially in the casewhere the internal diameter of the instrument needs to have a definedminimal dimension required by the function to be performed by theinstrument. Also as the number of layers increases, the stiffness of theflexible portions will increase, especially of the more proximalportions. Such an increase of stiffness and outer diameter of theinstrument will hinder its application and ultimately will make ituseless.

In order to have an instrument with an increased bending capacitywithout increasing the diameter or stiffness to unacceptableproportions, it is possible to combine the different longitudinalelements to be used for actuating the bending of the different flexibleportions in the handling portion into one and the same layer, wherebythe number of layers is substantially reduced. This is possible becauseit is only necessary to have three longitudinal elements for fullycontrolled actuation of one flexible portion. Therefore a layerconsisting out of for example 12 longitudinal elements can be used foractuating 4 flexible portions. In FIGS. 14, 15, 18 and 19 there areshown instruments that are equivalent to an instrument having multiplelayers that actuate multiple flexible portions at each end, but wherethere is only a reduced number of layers in that these intermediatelayers contain groups of 3 longitudinal elements.

A first embodiment of such an instrument is shown in the FIGS. 14 and 15that show the handling end portion of such an instrument only. It isobvious that the actuating end portion could be identical to the variousactuating end portions as described above. As shown the instrument ofFIGS. 14 and 15 is composed of three layers, an inner layer orcylindrical element 120, an intermediate layer 121 and an outer layer orcylindrical element 122. As seen along the longitudinal direction theinstrument has a rigid end zone 125 forming the handling end portion, aflexible zone 126, a rigid zone 127, a flexible zone 128, a rigid zone129, a flexible zone 130, a rigid zone 131, a flexible zone 132 and arigid zone 133. At the actuating end portion (not shown), the instrumenthas corresponding zones comprising alternating flexible and rigid zonescomparable to the instrument shown in FIG. 9 and of constructions asdescribed above.

The inner and outer layer 120 and 122 are continuous cylindricalelements with rigid and flexible portions which may be obtained asdescribed in the European patent application 08 004 373.0. Theintermediate layer 121 comprises a number of longitudinal elements 135(see FIG. 15) which are all parallel to the longitudinal axis of theinstrument and a number of rigid rings 136, 137, 138, 139 and 140. Eachof the rings 136-140 is provided with a number of openings extending inthe longitudinal direction parallel to the axis of the instrument,through which the longitudinal elements 135 can pass. The rigid rings136-140 are coinciding with the rigid zones 125, 127, 129, 131 and thebeginning part of the rigid portion 133.

The longitudinal elements 135 are divided into four groups, each groupcomprising at least three longitudinal elements 135 which are preferablyregularly spaced along the circumference of the intermediate layer 121.The first group of longitudinal elements 135 has its ends connected tothe rigid ring 136 and the elements are further guided through openingsin the other rings 137-140. The second group of longitudinal elements135 has its ends connected to the rigid ring 137 and the elements arefurther guided through the openings in the rings 138-140. The thirdgroup of longitudinal elements 135 has its ends connected to the rigidring 138 and the elements are further guided through the openings in therings 139 and 140. The fourth group of longitudinal elements 135 has itsends connected to the rigid ring 139 and the elements are further guidedthrough the openings in the ring 140. The rings 136-140 are connected toat least one of the inner and outer layer 120 and 122.

As a result of the fact that there are four groups of longitudinalelements each acting on a different part of the handling end portion ofthe instrument, this instrument is exactly comparable to the instrumentof FIG. 9 in which there are four bending possibilities for the handlingend portions which can be operated through the bending of thecorresponding parts in the actuating end portion or by four groups ofactuators in the actuating end portion as in FIG. 6, 7 or 8. Theimprovement of this embodiment is especially the use of one layercombining the different groups of longitudinal elements whereby thediameter and the flexibility of the instrument of FIG. 14 become smallerthan of the instrument of FIG. 9.

In FIGS. 18 and 19 there is shown an instrument in which the principleof having more than one group of longitudinal elements in one layer hasbeen applied for an instrument which is comparable to an instrumenthaving eight layers of longitudinal elements for transferring bendingmovement from the actuating end portion to the handling end portion.Actually the instrument of FIGS. 18 and 19 has two intermediate layerseach comprising four groups of longitudinal elements.

In the handling end portion shown in FIGS. 18 and 19 the instrument haseight flexible zones 141-148 and nine ring zones 149-157 defining thedifferent bending zones. The first four flexible zones 141-144 arecontrolled by means of longitudinal elements contained in the first orinner intermediate layer, whereas the second four flexible zones 145-148are controlled by means of longitudinal elements contained in the secondor outer intermediate layer. The instrument has in fact five layers, aninner continuous layer 160, a first or inner intermediate later 161containing the first group of longitudinal elements, an intermediatecontinuous layer 162, a second outer intermediate layer 163 containingthe second group of longitudinal elements and an outer continuous layer164. The layers 160, 162 and 164 are standard layers or cylindricalelements consisting of flexible and rigid portions as defined above. Thezones 141-144 and 149-153 do not have to be surrounded by the layers 163and 164 but could be surrounded by an extended flexible portion of outerlayer 164 to form an uniform outer diameter.

The actuating end portion can be of any construction as described aboveas long as the number of actuated flexible zones corresponds to thenumber of handling end flexible zones. The operation of this embodimentis comparable to an instrument having eight layers of longitudinalelements, implying a total of ten layers. Because of the combination offour groups of longitudinal elements in one layer each, the number oflayers has been reduced to five with a corresponding reduction of thediameter and stiffness. Nevertheless this instrument allows eightsimultaneous but independent bending operations to be performed by theinstrument, thereby expanding the possibilities of its use without asubstantial increase of the diameter and stiffness.

Obviously any combination of the number of layers, longitudinal elementsper layer and number of longitudinal elements per group can be made toobtain the optimal solution for various applications.

In the FIGS. 16 and 17 there is shown how the instrument according tothe invention can be used in a convenient way, while at the same timethe penetration in the working area can be restricted to a single tubesection. This is especially important in applications where the targetto be handled can only be approached through only one single way, whichis for example the case in a number of surgical treatments.

In the FIGS. 16 and 17 there is shown an external tube 170 which is usedas a guiding tube for a number of endoscopic instruments. The externaltube 170 comprises a single tube section 171 which extends up till theline B-B in FIG. 16. Above this line the external tube 170 is composedof a central tube section 172 and two branch tube sections 173 and 174,which are merging together at the level of the line B-B. The single tubesection 171 is the part of the external tube used for penetration. Inthe embodiment shown, five endoscopic instruments are inserted into theexternal tube 170, three through the central tube section 172 and onethrough each of the branch tube sections 173, 174. The endoscopicinstrument 175 is for example a viewing pipe, whereas the endoscopicinstruments 176 and 177 are used for the supply and/or discharge ofgasses and/or liquids to and from the target area. The endoscopicinstruments 178 and 179 are according to the invention with multipleorientation possibilities and are used as instruments for performingsome operations in the target area. In order to allow access through thebranch tube sections 173 and 174, the intermediate zone of theeinstruments between the handling end portion and the actuating endportion must be flexible as well, so that they can follow the curvedprofile of the branch tube sections. In view of the multiple orientationpossibilities of each of the instruments 178 and 179 it becomes possibleto allow these instruments to work on the same spot in the target areawithout interfering with each other as shown in the FIG. 16.

The external tube 170 may be a rigid tube, but it is also possible touse at least for the section 171 a flexible tube with multiple bendingpossibilities comparable to the instrument according to the invention.The same applies to the endoscopic instruments 175, 176 and 177. In theembodiment shown they have the shape of a rigid tube, but it may beflexible instruments according to the invention with multiple bendingpossibilities.

In the FIGS. 20 and 21 there is shown schematically two importantapplications of the instrument according to the invention in which themultiple orientation possibilities are used. It is accepted that aninstrument 190 according to the invention must be introduced in a canalsystem 191, which system is very sensitive to contact with theinstrument or parts thereof so that the contact between the instrumentand the canal walls must be avoided as much as possible. Such a canalsystem may be present in the human body such as for example the humanlung, but it may also be a technical instrument with sensitivecomponents which must be serviced.

In FIG. 20 it is accepted that the geometry of the canal system 191 hasalready been mapped by means of an imaging technique and stored in anelectronic device 192. The information of the device 192 is transferredto the control system 193 which is used to define the orientation of thedifferent zones of the handling end portion of the instrument at anymoment that the instrument is introduced in the canal system. The system193 is therefore connected to the actuating end portion of theinstrument 190. For safety reasons a viewing system is also connected tothe control system 193 whereby the actual situation at the handling tipof the instrument can be followed. Upon introduction of the instrumentin the canal system 191, the actual position of the handling tip iscontrolled and based upon the information stored in the device 192 andthe actual position of the handling tip the orientation of the differentzones in the handling end portion is controlled so that the handling endportion of the instrument is following exactly the predetermineditinerary through the canal system 191, such as shown in the FIGS. 20B,20C and 20D. This may be dynamic process in which each time that thehandling tip is progressing further in the canal system, the orientationof the different zones of the handling end portion is readjustedautomatically, thereby avoiding contact between the instrument and thecanal walls.

In the embodiment shown in FIG. 21 it is accepted that the canal system191 has not been mapped and stored. In this situation the handling tipmust be controlled by means of the viewing system 194. For that purposea joy stick 195 has been provided by means of which the orientation ofthe flexible zones of the handling end portion can be controlled. Eachtime the handling tip is progressing the orientation of all the zones iscontrolled by means of the joy stick 195 and information stored in thedevice 193 about the way along which the instrument has alreadyprogressed in the canal system 191. In this way also the contact betweenthe instrument and the canal walls can be avoided or at leastsubstantially reduced.

It is obvious that the invention is not restricted to the describedembodiments as shown in the annexed drawings, but that within the scopeof the claims modifications can be applied without departing from theinventive concept.

1-11. (canceled)
 12. An instrument for, at least, endoscopicapplications comprising a tube like member having a handling end portionhaving at least two flexible portions and a number of actuating meanslocated at an actuating end portion, and longitudinal elements fortransferring the movement of the actuating means to the handling endportion resulting in a change of orientation thereof, the number ofactuating means corresponding to the number of flexible portions, andeach actuating means being connected by means of its own set oflongitudinal elements to a part of the handling end portion foreffecting a change of orientation of one of the flexible portions,wherein at least one actuating means is rotatably arranged by means ofeither a ball shaped member or a ball bearing.
 13. The instrument asclaimed in claim 12, wherein said at least one ball shaped member isrotatably arranged within a spherical flange.
 14. The instrument asclaimed in claim 13, the instrument having a first actuating member witha first ball shaped member provided with a first annular flange having aset of openings arranged along a circular line, a first set oflongitudinal elements being connected to said set of openings.
 15. Theinstrument as claimed in claim 14, the instrument having a secondactuating member having a second ball shaped member provided with asecond annular flange having a first set of openings arranged along afirst circular line and second set of openings being arranged along asecond circular line, said first set of longitudinal elements beingguided through said first set of openings in said second annular flangetowards said set of openings in said first annular flange, a second setof longitudinal elements being connected to said second set of openings.16. The instrument according to claim 15, wherein said first circularline has a first diameter and said second circular line has a seconddiameter, said first diameter being equal to said second diameter. 17.The instrument according to claim 14, wherein said first set oflongitudinal elements are connected to said first annular flange at afirst distance to a longitudinal axis of the instrument, which distanceis greater than a second distance between said first set of longitudinalelements and said longitudinal axis at the handling end portion.
 18. Theinstrument according to claim 15, wherein the at least one sphericalflange includes a first spherical flange, the second actuating member isa hollow tube like element including said second ball shaped member, atube and said first spherical flange, said first ball shaped memberfitting into said first spherical flange.
 19. The instrument accordingto claim 18, wherein the at least one spherical flange includes a secondspherical flange, the instrument including a cylindrical element havingan end portion provided with said second spherical flange, said secondball shaped member fitting into the second spherical flange, thecylindrical element also having a rigid portion including a number ofslits arranged parallel to a longitudinal axis of the instrument andspaced regularly around a circumference of the rigid portion, said firstand second longitudinal elements being guided through said slits. 20.The instrument according to claim 12, wherein the instrument includes adisc mounted movable on a cylindrical element by means of said ballbearing, said disc being provided with a number of openings along anouter circumference, said longitudinal elements being connected to saiddisc through said openings.
 21. The instrument according to claim 20,wherein an orientation of said disc is controlled by actuators.
 22. Theinstrument according to claim 12, wherein the instrument is composed ofa number of cylindrical elements located in layers and in that each setof longitudinal elements is located within one of these layers.
 23. Theinstrument according to claim 22, wherein each set of longitudinalelements is located in a separate layer.
 24. The instrument according toclaim 22, wherein a number of sets of longitudinal elements are locatedin the same layer in which the elements are located parallel to thelongitudinal axis of the instrument.
 25. The instrument according toclaim 22, wherein the instrument is composed of a number of cylindricalelements located in layers, comprising an outer protective cylindricalelement and an inner protective cylindrical element.
 26. The instrumentaccording to claim 22, wherein the instrument has at least twointermediate cylindrical elements containing different sets oflongitudinal elements and in that between each pair of adjacentintermediate elements there is provided a separation layer.
 27. Theinstrument according to claim 12, wherein each set of longitudinalelements are laser cut longitudinal elements in a cylindrical tube.